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Myths and facts about pain management in childbirth

(BPT) - Nearly half of first-time moms (46 percent) said the labor and delivery pain they experienced with their first child was better than they expected, according to a nationwide survey commissioned by the American Society of Anesthesiologists (ASA).

The survey findings suggest that being proactive in managing pain with your physician anesthesiologist is important, whether laboring moms demand an epidural right away, choose other medical pain management methods, use complementary techniques only or opt for a combination. Nine out of 10 women said pain management was effective, no matter what method they chose.

The survey also revealed that many first-time moms held some false beliefs about labor pain management before they experienced childbirth:

* 74 percent thought you couldn’t have an epidural after a certain time in labor (you can have one up until the baby’s head begins emerging, known as crowning)

* 44 percent feared pain at the epidural injection site would last for a prolonged time

* 26 percent believed an epidural slows labor

* Most concerning, 20 percent believed only one pain management option could be provided during labor and 16 percent didn’t know

Expectant mothers should work with their health care providers, including their physician anesthesiologist, to discuss what pain management methods may work best for them.

“A wide variety of options exist to manage pain, from epidural to massage, nitrous oxide to breathing techniques and it’s acceptable to change methods or use a combination during nearly every stage of labor,” said ASA President Dr. James D. Grant, M.B.A., FASA. “But it’s also important to be flexible, since it may be necessary to change pain-management methods based on the labor process itself.”

When it hurt most and what it was like

While slightly more than half said having contractions was the most painful aspect of delivery, about one in five noted pushing or post-delivery was most painful. Moms 18 to 39 were more likely to say post-delivery pain was the most painful aspect than those 40 and older. The most common description of the level of pain experienced was extreme menstrual cramps (45 percent), while 16 percent said it was like bad back pain and 15 percent compared it to a broken bone.

So, what pain management did they choose?

While the epidural was the most common option, chosen by 73 percent, 40 percent used complementary techniques (breathing, water birth, massage, visualization or hypnosis). Thirty-one percent used both medical (epidural, medication delivered through an IV or injection, spinal block or nitrous oxide) and complementary methods.

Nitrous oxide was rarely used. Only 2 percent of moms had nitrous oxide, and none 40 and older or who lived in the Midwest used it to manage labor pain. “This suggests that despite the buzz, nitrous oxide may not be widely available yet, or that mothers aren’t convinced it would be very helpful,” said Grant.

In the future

If they were to give birth again, most moms would choose the pain management method, whether medical and/or complementary, they originally chose during their first childbirth, with the majority (60 percent) opting again for an epidural to manage their pain.

“Every woman’s pain during labor is different and talking with your health care provider and physician anesthesiologist can help you decide which pain management method will give you the best labor and delivery experience,” said Dr. Grant.

The ORC International Caravan Omnibus Survey was conducted online among 912 mothers (18 years or older) of children ages 0-8, whose first child was born either via vaginal childbirth or Cesarean section (C-section) after the onset of labor. Ultimately, 73 percent had a vaginal childbirth.

For more information about pain management during labor and delivery and the importance of seeing a physician anesthesiologist, visit asahq.org/labor.

To learn more about the ASA, an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology, visit asahq.org.